|
047M3GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M3GZ
|
| Hospital Charge Code |
4438
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M441
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M441
|
| Hospital Charge Code |
2252
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047M44Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M44Z
|
| Hospital Charge Code |
2253
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047M45Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M45Z
|
| Hospital Charge Code |
2254
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047M46Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M46Z
|
| Hospital Charge Code |
2255
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047M47Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047M47Z
|
| Hospital Charge Code |
2256
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047M4D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4D1
|
| Hospital Charge Code |
4439
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M4D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4D6
|
| Hospital Charge Code |
4440
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M4DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4DZ
|
| Hospital Charge Code |
4441
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M4EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4EZ
|
| Hospital Charge Code |
4442
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M4FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4FZ
|
| Hospital Charge Code |
4443
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047M4GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047M4GZ
|
| Hospital Charge Code |
4444
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N041
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N041
|
| Hospital Charge Code |
2257
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N04Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N04Z
|
| Hospital Charge Code |
2258
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N05Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N05Z
|
| Hospital Charge Code |
2259
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N06Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N06Z
|
| Hospital Charge Code |
2260
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N07Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N07Z
|
| Hospital Charge Code |
2261
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N0D1
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0D1
|
| Hospital Charge Code |
4445
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N0D6
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0D6
|
| Hospital Charge Code |
4446
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N0DZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0DZ
|
| Hospital Charge Code |
4447
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N0EZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0EZ
|
| Hospital Charge Code |
4448
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N0FZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0FZ
|
| Hospital Charge Code |
4449
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N0GZ
|
Facility
|
IP
|
$3,913.00
|
|
|
Service Code
|
ICD 047N0GZ
|
| Hospital Charge Code |
4450
|
| Min. Negotiated Rate |
$3,913.00 |
| Max. Negotiated Rate |
$3,913.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,913.00
|
|
|
047N341
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N341
|
| Hospital Charge Code |
2262
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
|
047N34Z
|
Facility
|
IP
|
$8,623.00
|
|
|
Service Code
|
ICD 047N34Z
|
| Hospital Charge Code |
2263
|
| Min. Negotiated Rate |
$8,623.00 |
| Max. Negotiated Rate |
$8,623.00 |
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,623.00
|
|
